Dr. Mandy Huggins Armitage

Thoughts, musings, and a little bit of education from a female physician in the Sports Medicine world.

Monthly Archives: May 2012

How much contact is too much in youth sports?

Email

I recently posted a blog about errant comments made in the sports media regarding concussion. After my sister read the post, she had a very valid question about contact sports in kids. Specifically, “How does an uneducated parent know what is safe for their young kids in sports?” She wanted to know if there is any way to determine how much contact is too much in youth sports. The answer to that? I don’t know. There is no good answer for that right now, unfortunately. However, here is what we do know:

Kids should be managed more cautiously than adults.

Kids may take longer to recover after concussion.

Kids’ brains are still developing, which may affect their short- and long-term recovery.

No protective equipment of any kind or cost can prevent concussion.

The long-term effects of multiple head injuries can be devastating – depression, anxiety, decreased reaction time, cognitive impairment, emotional lability, and so on.

Interestingly, a recent study out of Virginia Tech earlier this year investigated the level of impact sustained by youth football players (age 7-8) with the same technology used in studies with older subjects; it was the first study of its kind with youth subjects. Contrary to Derrick Mason’s comments, the study found that although these kids have a lesser body mass and play at slower speeds, they still sustained high magnitude impacts – impacts similar in magnitude (80 g!) to those in high school and college football. It also found that the higher impacts were sustained during practices, not in games like at the high school and college level. The frequency of said impacts occurred less frequently in youth football, but nonetheless, they still occurred. The results of this study prompted Pop Warner president Jon Butler to propose a rule change: limit the amount of contact drills to 1/3 of all practice time. Interestingly, after perusing the Pop Warner website, I was unable to find mention of said rule change. The website does make it very clear, however, that in Pop Warner there is an “absence of catastrophic injuries” and that the injury rate is a fraction of that of high school and college football. Well, no kidding! They also play a fraction of the time. That doesn’t mean it’s any less dangerous.

So, back to my sister’s question. Is there a way to determine if contact sports are safe for her kids? There is not. This is a tough situation. Even leading experts disagree. Dr. Robert Cantu of Boston University recommends that children under the age of 14 not play sports such as football, lacrosse, and ice hockey. He also questions whether kids should be heading the ball in soccer. On the other hand, Kevin Guskiewicz, ATC at the Unviersity of North Carolina, disagrees with that recommendation and instead advocates for safer tackling techniques. Clearly, more research is needed in this area. What is not clear is how to help parents make decisions regarding their kids and sports.

Bill Romanowski – a decade behind current concussion management

Email

“Linebackers can play a little bit dizzy. Quarterbacks can’t play when they’re dizzy.” These are just a few of the rambling statements made by Bill Romanowski on 5/9/12 in an interview with Chris McKendry on ESPN’s SportsCenter. He made remarks in response to Cris Carter’s comments the previous day regarding bounties. Carter alleged that years ago, Romanowski threatened to intentionally injure him before a game. Romanowski denied the allegation but went on to talk about how intensely he played the game – in his opinion, it wasn’t a good enough hit if he didn’t end up with dizziness or seeing stars. He actually used the phrase “getting his bell rung.” Seriously??  It’s poor form to use that phrase these days. He then went on to say, “This is football. This isn’t volleyball or baseball…” which implies that playing with a head injury should be the norm in football.

Statements like his make me cringe. I can’t believe this train of thought still occurs, especially with the recent suicides of retired NFL players and the impressive research regarding CTE. I really can’t believe that ESPN would interview a guy like Romanowski, given his obvious ignorance about concussion management.  I understand his compulsion to respond to Carter’s allegation. And I understand that he played in a different time. It was okay to play “with your bell rung” in his days. But to still speak of it so callously? As they say on Monday Night Countdown, “Come on, man!”

Just as concerning were Derrick Mason’s comments on Outside The Lines on the very same day. “I don’t worry about concussion or head trauma as much at a younger age, because these kids don’t generate as much force as NFL players.” Clearly he doesn’t understand that kids are more susceptible and that their developing brains are much different than those of adults. I’m not saying that all NFL players, current and retired, should understand every aspect of concussion assessment, management, etc., but I do think that ESPN should be more careful about these interviews. Someone watching this show, who doesn’t understand much about concussion, may listen to Mason’s comments and believe them. What if a young father takes Mason’s comments to his son’s Pee Wee football game? To Mason’s credit, he believes that if a player is questionable for a concussion, he should sit out at least two games, no questions asked. At least something is sinking in.

This stuff is dangerous, and we need to be careful about what information is put out there for people to see and hear. It’s a hot topic right now. As a sports medicine professional, I’ll be the first to admit that we still have a lot of work to do before we fully understand concussion and all it involves. The good news is that this issue has become more well-known and discussed. I just hope the discussion doesn’t involve Bill Romanowski anymore.